1. Extension Agent reorganization for
Community Led Total Sanitation (CLTS)
Implementation and Monitoring
Ashley Meek and Michael Kennedy
Engineers Without Borders Canada
Monitoring for sustainable open defecation free status
Ibex Room, 09/04/2013

2. 1. How is ODF defined – what indicators are
used?
 ODF: Every household uses a latrine with
privacy, there is no shit in the bush(sharing is
acceptable)
 ODF ++: Every household has and uses a latrine
with cover and hand washing facility; all primary and
secondary schools, CBCC’s, religious
institutions, market centres and health centres in the
village have latrines with covers and hand washing
facilities

3. Verification Form

4. 2. Who conducts the monitoring and who
supports them?
 Typical Health Centre Organization
 Block System Organization
HSA: Health Surveillance Assistant
AEHO: Assistant Environmental Health Officer
AEHO
Sr. HSA
HSA HSA HSA HSA HSA HSA HSA HSA HSA HSA
AEHO
Block 1
(Sr. HSA; HSA; HSA)
Block 2
(HSA; HSA; HSA)
Block 3
(HSA;HSA;HSA;HSA)
Block 4
(HSA; HSA;HSA;HSA)
Block 5
(HSA; HSA; HSA;HSA)

5. 3. How often is monitoring done?
 Expectation Setting
 Basic Calculation of CLTS activities as a group
 The purpose is to provide a simplified guideline to HSA blocks so that they
can track their CLTS activities.
 Unique cultural and topographic conditions within each Health Centre’s
catchment area will impact the level of effort required for CLTS and block
formation.
 Extension staff are able to include CLTS in their regular planning and follow
up on the expectations they have set to determine how reasonable they are.

6. I
Number of HSAs
x
Days in a week
x
Weeks in a month
=
Workload Capacity
5 5 4 100
Mark With X Only complete for Category A activities
Task/Activity Areas
CategoryA
CategoryB
CategoryC
Number of HSAs
conducting Activity?
Number of
Location(s)?
Frequency per
month (for one
HSA for one
location)
Total
HSAs x Locations x
Frequency =
Office Work:
Nutrition; Malaria; Early Infant
Diagnosis; Drug Distribution
X 2 1 5 10
Patient Follow-up:
Palliative Care; Home-Based Care;
TB
X - - - -
Outreach Clinic:
Immunization; Growth Monitoring;
Family Planning; IEC
X 4 1 4 16
CLTS
Triggering; Follow-up
X 5 Number of OD Villages x 4.5 ÷ Number of months until target date
10
Monday Meeting
X 5 1 4 20
Data Collection/ Inspections:
VHR; Institutional Inspections;
Disease Surveillance; School Health
X 1 11 1 11
Water Testing
Testing; Chlorination
X 1 11 1/3 4
VHC Activities:
Training; Meetings
X 1 11 1 11
Specialized Tasks:
Larva Spraying; HTC (HIV); etc
X - - - -
Total Level of Effort Commitment
Determine Workload Capacity
Determine Expectations
826

7. 4. What system / methodology do they use
to collect and store data

8. 5. Where is data stored and who analyses
the data?
Local Health Center District / National

9. Group: One Two Three
Average
Percentage (Add
% of each group
then divide by
number of groups)
Health Centre Monthly Activities
Report
Numberof
Occurrences
Percentageof
workload
Numberof
Occurrences
Percentageof
workload
Numberof
Occurrences
Percentageof
workload
Numberof
Occurrences
Percentageof
workload
Numberof
Occurrences
Percentageof
workload
Numberof
Occurrences
Percentageof
workload
Numberof
Occurrences
Percentageof
workload
Numberof
Occurrences
Percentageof
workload
Task/Activity Areas
Office Work:
Nutrition; Malaria; Early Infant Diagn6osis; Drug Distribution
A
15
A ÷ Z
19 12 15 14 15 16
Patient Follow-up:
Palliative Care; Home-Based Care; TB
B
4C
B ÷ Z
C 0C C 2C C C
Outreach Clinic:
Immunization; Growth Monitoring; Family Planning; IEC
C
16
C ÷ Z
20 16 20 18 19 20
CLTS
Triggering; Follow-up
D
5
D ÷ Z
7 10 12 12 13 11
Monday Meeting E
20
E ÷ Z
25 20 24 22 22 24
Data Collection/ Inspections:
VHR; Institutional Inspections; Disease Surveillance; School
Health
F
9
F ÷ Z
11 10 12 12 13 12
Water Testing
Testing; Chlorination
G
5
G ÷ Z
7 4 5 5 6 6
VHC Activities:
Training; Meetings
H
9
H ÷ Z
11 10 12 12 13 12
Specialized Tasks:
Larva Spraying; HTC (HIV); etc
I
0
I ÷ Z
0 0 0 0 0 0
Total
Z
79 82 95 100
Total
HSAs x Locations x
Frequency =
10
-
16
10
20
11
4
11
-
83
9
6. Are you monitoring progress against plans or targets, if so how is
this done and how does this impact on the progress or on the targets /
plans?

10. District
(e.g. AEHO)
HC
Other HC
(e.g. HSA, sHSA)
Other Catchment
Area
(e.g. HSA)
V
HC
(sHSA)
HC
Traditional
Leader
NGO
representative
7. Who declares a community ODF? Who
validates / certifies?
• HSA block w/ 1-2 independent verifiers

11. Verification Process Flow
Step 1:
Self –
Identification
• All households
Step 2:
Verification
Team
Formation
Verification In
1 Village
• Sample 10 % of
households in 1
village
Verification In
An Area
• Sample 5 % of
households in an
area

12. 8. (How) is monitoring continued post-ODF?
 Extension Agents responsible for the community
must do regular 6 month sanitation checks for the
National M&E framework.
 The HSAs plan monthly CLTS and Sanitation
activities with their Block

13. 9. What feedback mechanisms /
information sharing systems are in place?
District
Environmental
Health Officer
Assistant
Environmental
Health Officer
HSA Block

14. 10. What are the key challenges with this
approach to monitoring?
 Training and roll out – understanding benefits
 Lack of stationary / resources
 Lowest common denominator effect
 Negative competition between blocks and/or
block members
 Over simplified tools resulting in
misunderstandings or missed activities
 Lack of group management resulting in blocks
not creating their monthly plans or being held
accountable to them

15. 11. What have been its main successes?
 Streamlined training of HSAs
 Prioritizing CLTS Monitoring activities
 Understanding impact of CLTS activities on
extension agent workload overall.
 Accountability
 Monitoring CLTS activities using the Block
System at the field and district level